SAN DIEGO -- Women who have migraines with aura may be at higher risk for major cardiovascular events and thrombosis, according to two studies.

Action Points

These studies were published as abstracts and will be presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

These studies suggest that migraine with aura appears to be a major risk factor for cardiovascular occurrence in women, and it is associated with a particularly high risk of thrombotic complications in women who used contraceptives.

SAN DIEGO -- Women who have migraines with aura may be at higher risk for major cardiovascular events and thrombosis, according to two studies.

In the first study, researchers led by Tobias Kurth, MD, ScD, of the National Institute of Health and Medical Research in Bordeaux, France, found that migraine with aura is a "strong relative contributor" to an increased cardiovascular risk.

In the second, Shivang Joshi, MD, of Brigham and Women's Hospital in Boston, and colleagues found that migraine sufferers – and especially those with aura – who use combined hormonal contraceptives are at elevated risk for thrombotic events.

Both studies will be presented at the American Academy of Neurology meeting in March.

Kurth and colleagues looked at 27,860 women, ages 45 or older, in the prospective Women's Health Study who were free of cardiovascular disease at the start of the study, and for whom both self-reported information on migraines and lipid measurements were available.

At the start of the study, 5,130 women reported having migraines, including 1,435 who had migraine with aura.

Over 15 years of follow-up, there were 1,030 major cardiovascular events, yielding an incidence rate (IR) of 2.4 per 1,000 women per year.

Among the measured risk factors, the strongest contributor was a systolic blood pressure of at least 180 mmHg, with an IR 9.8 per 1,000 women per year.

But migraine with aura was a strong second, with an IR of 7.9 per 1,000 women per year followed by:

Diabetes: IR 7.1 per 1,000 women per year

Family history of premature myocardial infarction: IR 5.4 per 1,000 women per year

Current smoking: IR 5.4 per 1,000 women per year

Body mass index of at least 35 kg/m2: IR 5.3 per 1,000 women per year

"After high blood pressure, migraine with aura was the second strongest single contributor to risk of heart attacks and strokes," Kurth said in a statement.

The combination of traditional risk factors still plays the major role in cardiovascular risk, the researchers noted.

Kurth said people with migraine with aura can lower their risk, much as other people can, by not smoking, exercising, and keeping their blood pressure low and weight down.

The use of combined hormonal contraceptives is controversial in women who have migraines with aura, Joshi and colleagues noted, mainly because of concerns about thrombotic risks.

Newer combinations – such as drospirenone, the norelgestromin/ethinyl estradiol transdermal patch, and the etonogestrel/ethinyl estradiol vaginal ring -- have been associated with an increased risk of thrombotic events, including deep vein thrombosis (DVT).

But there are limited data on the newer combinations in women who have migraines with aura, they noted.

To help fill the gap, they turned to the Partners Healthcare registry of patient data to come up with a cohort with migraine who had been prescribed one of the newer contraceptives, or an older combination, including levonorgestrel/ethinyl estradiol, norethindrone/ethinyl estradiol, and norgestimate/ethinyl estradiol.

Over the period 2001 to 2012, 145,304 women had used the selected contraceptive combinations, including 2,691 who had migraine with aura and 3,437 who had migraine without aura.

Those whose migraines included aura were more likely to have had clots with all types of contraceptives than women with migraine without aura.

For instance, they found that 7.6% of women who had migraine with aura and used drospirenone-ethinyl estradiol were diagnosed with DVT. Among women on the same combination but whose migraines did not have aura, the rate was 6.3%.

Overall in women who used combination contraceptives, the rate of thrombotic complications was higher among those who suffered from migraines than among those who did not.

Also, the rate of thrombotic complications associated with all combination contraceptives was higher in women whose migraines had aura than in those without aura.

"Women who have migraine with aura should be sure to include this information in their medical history and talk to their doctors about the possible higher risks of newer contraceptives," Joshi said in a statement.

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